This needs immediate attention
American Surgeon Dr Elizabeth Potter blowing the whistle on a new bill Congress just put out
The new bill takes away insurance companies liability to have to pay for bre... View MoreThis needs immediate attention
American Surgeon Dr Elizabeth Potter blowing the whistle on a new bill Congress just put out
The new bill takes away insurance companies liability to have to pay for breast cancer reconstructive surgery on all high risk prevention patients
“There is a bill that has been introduced in Congress that, on the outside, looks like it might be a really good thing for the patients that I care for, for patients affected by breast cancer. But on the inside, there's some real problems with it, and I need your help in raising awareness about that. So when I see a patient who has breast cancer or a risk of breast cancer, there's one thing that I always say to them, and it's so important. It's that the Women's Health and Cancer Rights Act of 1998 guarantees that if their insurance company covers their mastectomy, they have to cover their reconstruction.
So as you can imagine, when women hear that, they're so relieved, right? They're like, "Okay, I have to lose my breast, but I'm gonna be able to have reconstruction."
That all changes
“The number one thing is that previously in the Women's Health and Cancer Rights Act, coverage for all breast reconstruction really hinged on one thing, and that was if your insurance covers your mastectomy, they have to cover your reconstruction. When I read this new bill, I looked for that, and what I saw was that they had changed that fundamental thing.
They changed that to say now reconstruction hinges on a diagnosis of breast cancer. That may sound similar, but that means that all of our patients with BRCA1 and BRCA2, all of our patients with other high risk for breast cancer, they would not have coverage for breast reconstruction under this new act, and there's no other thing that's providing coverage. So this new amendment would remove coverage for breast reconstruction for all of those patients”
The bill limits coverage to those with a formal breast cancer diagnosis (excluding high-risk preventive cases like BRCA1/2 mutations) and tying reimbursements to outdated CPT codes instead of modern ones (like S codes for muscle-sparing reconstructions).
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